TRICARE Prime Point-Of-Service (POS) option
The POS option allows non-Active Duty Service Members enrolled in TRICARE Prime, TPR or TPRADFM to seek non-emergency healthcare services from any TRICARE-authorized provider without referrals.
The POS cost-share applies when:
- The patient receives medical or behavioral healthcare from a civilian TRICARE-authorized provider without an appropriate referral/authorization
- The patient self-refers to a network specialty care provider after Humana Military authorizes a referral to see a military hospital or clinic specialty care provider
- The patient enrolled at a military hospital or clinic self-refers to a civilian provider, other than his or her PCM, for routine care
- The patient self-refers to a non-network specialty provider for non-emergency behavioral healthcare
The POS option does not apply to the following:
- Active Duty Service Members (ADSM)
- Newborns and newly adopted children in the first 60 days after birth or adoption
- Emergency care
- Clinical preventive care received from a network provider
- Beneficiaries with Other Health Insurance (OHI)
- Outpatient behavioral health visits with network providers for covered conditions that are medically or psychologically necessary
When using the POS option, beneficiaries may be expected to pay a deductible and 50 percent of the TRICARE allowable charge. POS costs do not apply to the catastrophic cap. Find out more about specific inpatient costs
Note: ADSMs may not use the POS option and must always obtain referrals and/or authorization for civilian care. If an ADSM receives care without a required referral or prior authorization, the claim is forwarded to the Service Point of Contact (SPOC) for payment determination. If the SPOC approves the care, the ADSM does not have to pay the bill. If the SPOC does not approve, the ADSM is responsible for the entire cost of care.